Health experts across the country agree: we are in the midst of a mental health pandemic and have good reason to believe that this mental health crisis will lead to increased cases of depression1 throughout the year.
This debilitating illness currently impacts more than 17.3 million American adults, with research2 showing rates have tripled as a result of the COVID-19 pandemic. Unfortunately, many sufferers — an astounding 6.2 million3 — do not find relief using antidepressant medications. Depression treatments are simply not one-size-fits-all. As we rebound from the COVID-19 pandemic, it is more critical than ever for clinicians to take a hard look at our patients and their needs to ensure we are exploring all available options as early as we can, to give them the best chance of relief — and potential remission — from this disease that plagues too many.
The Two Health Crises
Because the physical toll of COVID-19 is very visible, the mental health ramifications were often overlooked and not prioritized early on when fear of contracting the virus permeated every element of life. As businesses closed, schools turned virtual and quarantine orders extended, the impact of the pandemic snowballed. Young adults saw major milestone events, such as graduations or proms, cancelled and 46 percent of parents4 said their teen showed signs of worsening mental health. Parents were forced to juggle their careers and childcare, causing an increase in depression, stress, and loneliness.5 Job loss also contributed to an increase in rates of depression or anxiety1 at 53.4 percent.
Unfortunately, depression and anxiety are not the only lingering effects. We’ve seen patients who have relapsed, leaning back on substance use in an effort to alleviate the feelings of hopelessness that the uncertainty of the pandemic has brought on. In fact, recent statistics show 13 percent of adults6 have turned to substances over the last year to help themselves cope.
What Happens Next?
Now that vaccines are rolling out and people are slowly resuming a bit of normalcy, many will likely start to feel better, but for others, the battle with mental health will continue. This pandemic has impacted us all, but our frontline workers, especially those in health care, have been the ones to experience unprecedented stress. As a result, I expect to see an increase in post-traumatic stress symptoms7 in frontline employees and long-term effects on their overall mental health.
Shifting back to pre-pandemic lifestyles without the opportunity to properly process what has happened over the last 15 months and the grief and pain associated with it can be dangerous. As depression rates rise, so too will the demand for treatment, ultimately resulting in a shortage of mental health professionals equipped to support those suffering. In my region, patient volume has exponentially increased. We are lucky to have been able to rely on telehealth technology that became popular last year to help keep us connected and providing that critical care.
As shelter in place orders began and people found themselves confined to their homes, many mental health professionals stayed open for in-person care. Clinicians in underserved areas began scheduling virtual appointments to reach patients who would not have otherwise been able to receive in-person care — and the use of telemedicine skyrocketed8 as a result.
Thanks to its benefits and convenience, this newer technology has become a more widely accepted method of care amongst my patients who understand the importance of seeking help but do not yet feel comfortable returning to in-person treatment. Since an increasing number of practices are safely seeing patients in-person, I do predict a majority of patients will return to in-person care in the coming months, and telemedicine is a great alternative in the meantime. I also believe the reliance on telemedicine for behavioral health care will outlast the pandemic, especially for those in less populated areas and with remote working expected to continue.
A Rise in Alternative Treatment Options
While it does appear we are nearing the end of the COVID-19 pandemic, people are still struggling with mental health illnesses and searching for new treatment options. Because statistics show medication therapy does not work for all depressed patients — in fact, research indicates9 the likelihood of remission drops in depressed patients who do not benefit from multiple antidepressant medication attempts — one of my top recommendations for adult patients struggling with depression who don’t benefit from antidepressants is TMS therapy. TMS therapy, or transcranial magnetic stimulation, is a non-drug, non-invasive treatment that uses magnetic pulses to stimulate areas of the brain that are underactive in depression. Of my patients who have been treated with NeuroStar Advanced Therapy since the opening of my practice in early 2020, we have seen a 70 percent response rate and more than a 50 percent remission rate. And this is only the beginning. It is important that both clinicians and patients alike are aware of this technology. Hope is not lost when drugs fail.
While the first TMS device received FDA approval back in 2008, it still seems to be a relatively unknown treatment option to patients and sometimes even clinicians. I’ve heard colleagues say they learned about electroconvulsive therapy in residency, but not TMS therapy — which means there is an opportunity to enhance our conversations about alternative treatments for depression. At my practice, we’ve recognized this critical need for education and have launched a campaign designed to raise awareness about TMS therapy among fellow health care professionals, resulting in interest from local universities who want information to help educate their students.
Given the growing prevalence of depression within the US, and the probability that cases will significantly increase, physicians would be wise to help mitigate the damage by making patients aware of non-drug treatment options, like TMS, as early on in their treatment journeys as possible. TMS is safe, effective and readily available. It is covered by most major insurers, free of the side effects often associated with antidepressants, and patients can drive themselves home after treatment.
We all agree that the “end” of the COVID-19 pandemic does not mean a magical and seamless switch back to pre-pandemic life. That transition will be a slow one as the impact of the past 15 months may be long-lasting, particularly for those who have felt an incredible weight on their mental health. The good news is that there is hope with TMS therapy. Remission from depression is possible when we look outside of antidepressants and think differently about how we approach mental health wellness.
- Panchal N, Kamal R, Cox C, Garfield R. The implications of COVID-19 for mental health and substance use. Kaiser Family Foundation. Published February 10, 2021. Accessed May 17, 2021. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
- Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galeo S. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Network Open. Published September 2, 2020. doi:10.1001/jamanetworkopen.2020.19686
- Major Depression. National Institute of Mental Health. Updated February 2019. Accessed May 17, 2021. https://www.nimh.nih.gov/health/statistics/major-depression
- Mott Poll Report / How the pandemic has impacted teen mental health. C.S Mott Children’s Hospital. Published online March 15, 2021. Accessed May 17, 2021. https://mottpoll.org/reports/how-pandemic-has-impacted-teen-mental-health
- Bargeron E. Survey shows single-parent households with young children bear the brunt of COVID-related stress. Georgetown University Health Policy Institute Center for Children and Families. Published online January 7, 2021. Accessed May 17, 2021. https://ccf.georgetown.edu/2021/01/07/survey-shows-single-parent-households-with-young-children-bear-the-brunt-of-covid-related-stress/
- Czeisler, MĖ, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic — United States, June 24–30, 2020. Centers for Disease Control and Prevention. Published online August 14, 2021. Accessed May 17, 2021. https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm
- Benfante A, Di Tella M, Romeo A, Castelli L. Traumatic stress in healthcare workers during COVID-19 pandemic: a review of the immediate impact. Front Psychol. Published online October 23, 2020. doi:10.3389/fpsyg.2020.569935
- Mochari-Greenberger H, Pande RL. Behavioral health in America during the COVID-19 pandemic: meeting increased needs through access to high quality virtual care. Am J Health Promot. Published February 8, 2021. doi.org:10.1177/0890117120983982d
- Haddad PM, Talbot PS, Anderson IM, McAllister-Williams RH. Managing inadequate antidepressant response in depressive illness. Br Med Bull. Published online August 26, 2015. doi:10.1093/bmb/ldv034
This article originally appeared on Psychiatry Advisor